Adelaide South Rotary – May 2013

“A Different Approach To Psychiatry”
Adelaide South Rotary – 9 May 2013
– Updated Notes –

Adelaide South Rotary picture
Many thanks Adelaide South Rotarians!

Psychiatry is in decay – but it is not in decline – and there is an alternative.

Professor Iain McGregor, Professor of Psychopharmacology, School of Psychiatry, University of Sydney, in promoting his recent book “Meds for Heads” with a tour of speaking engagements to psychiatrists he had this in his introductory blurb…

“Australia’s use of prescription psychotropic drugs has escalated recently with a more than doubling of antidepressant and atypical antipsychotic drugs over the past 10 years. Many commonly used prescription psychotropics are old drugs with questionable efficacy and troubling side effects. Very few novel compounds are coming down the pharmaceutical pipeline.”

Going back to the 1980’s my two take-away learnings about Psychiatry during my medical training were:

  1. Diagnosis is subjective – there are almost no blood tests, scans or even physical examination findings.
  2. First step is to rule out a non-psychiatric condition – eg blood test – syphilis, HIV, even scanning for a brain tumour

NOTE: the commonest ‘medical conditions’ I currently find in patient’s referred to me are…

  • insomnia / sleeping problems (including sleep apnoea)
  • low testosterone (related to testicular damage, eg from alcohol, or ‘male menopause’)

So when I finished in medical school, I decided that I wouldn’t be a psychiatrist, I’d be a GP.

I can still prescribe medication, make the DSM-IV diagnoses, order tests, access Medicare, and, it turned out that unlike a psychiatrist, I can do this and see patients directly – ie no referral needed.

Psychiatry is in decay.

1990’s had an initiative by the US Government, the “Decade of the Brain”, but all the research did not change the take-away lessons.

In the 2000’s It still did not change, but in fact got worse.

Dr Irving Kirsch (Ph.D), Professor of Psychology, University of Hull, UK was publishing studies that he subsequently turned into a book in 2010 “The Emperor’s New Drugs: Exploding the Antidepessant Myth”

The book outlined 3 key points

  1. When ALL controlled studies are analyzed, anti-depressants are not much better than a placebo (a sugar pill.)
  2. Anti-depressants have side-effects that mean that patients and doctors in the studies work out over time if they are getting placebo or not.
  3. When you give an ‘active placebo’ (a sugar pill with an added ingredient that produces side effects) so they can’t tell the difference, the benefits of anti-depressants disappear.

However, to quote Irving Kirsch page 152:

WARNING: DO NOT DISCONTINUE ANTI-DEPRESSANTS WITHOUT CONSULTATION

And I agree – see your doctor to get a proper plan for reducing or removing these medications!

Psychiatry is not in decline

These are massively profitable and best-selling drugs. The momentum and vested interests of drug companies is clear.

There is also the need of the psychiatric fraternity to put psychiatry on a legitimate ie medical/biological footing.

Neither of these will change.

Also as a society the government is paying the bills, and we are currently in the phase of ongoing expansion of government influence and expenditure, so this will not change soon either. The population is more and more looking to external sources to fix problems – whether it is pills, practitioners, or government programs.

These two influences will at some stage stop and reverse, but for the short and medium-term future they are still on the rise.

Disease-mongering  from Wikipedia:

Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses, and promoting public awareness of such, in order to expand the markets for those who sell and deliver treatments.

There is an alternative

Health-mongering – from me

Seeing healthy and normal responses, where others see disease and illness.

There are two aspects of the alternative which are

  • Character (Vs Personality / Personality ‘disorder’)
  • Life Skills

For example, Rotary is an organization based on someone’s ‘character’. So in reverse to psychiatry, Rotary is in decline but not in decay.

As another example of character, my first venture into teaching others Marketing back in 2003 was “Word of Mouth Magic”, which dealt with word of mouth reputation, referrals, recommendations etc ie character. For specific psychiatric situations and conditions, “Life Skills” may mean digging beneath the ‘diagnostic label’ eg Depression, for the actual symptoms and issues. For example any of these issues can cause someone to end up on the ‘merry-go-round’ of practitioners, medicines, therapists etc etc, but can be usefully addressed with Life Skills. The way ‘healthy / normal’ people would resolve these issues, can be taught to others as well.

  • sleeping problems – the Early Morning Waking of Depression for example.
  • “overwhelm” / “stress” / “too much to do, too little time”
  • hopelessness / lack of meaning and purpose in life
  • pain issues – especially back pain, tension headaches, neck, hips, knees joints
  • weight loss / eating – WITHOUT dieting.

If you have any questions then feel free to contact me (Martin) at DrMartinRussell.com

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